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How are you quitting the game? Are you using "quit to desktop" or are you just closing it. Cause one saves your settings, the other doesn't.
Jan 30 patch broke functionality for some people, no longer allowing the game to write to the documents folder for some reason.
Game will simply create new ones with default settings when you next launch it. This has fixed my issues of settings not saving in the past. Just be aware doing so will reset all of your game settings back to default and you will need to redo them all.
As mentioned check you have not got the Fallout76Prefs.ini set to read only. It is a common practice to do so to stop the game undoing the change to turn off the games built in VSync.